Pyogenic granulomas are common benign skin tumors. They frequently occur after trauma and can be induced by certain classes of medications. They are also seen in increased frequency during pregnancy. Pyogenic granu- lomas are vascular tumors or proliferations of vascular tissue. They occur in all races, and there is no age or gender predilection, although they are more commonly seen in pregnancy.
Clinical Findings: Patients often present with a bleeding papule or nodule that is beefy red and has a collarette of scale. Pyogenic granulomas are friable and bleed easily when manipulated. There is often a preceding history of trauma. The lesions are usually small (5 mm) papules, but some have been reported to be 1 to 2 cm in diameter. These benign growths can also occur on the mucosa, and another common but unique location is in a periungual position. They can be tender and occasionally can become superinfected. A characteristic finding is the “band-aid” sign. This sign represents the surrounding skin findings of a contact dermatitis caused by the frequent use of bandages to cover the pyogenic granuloma due to its propensity to bleed, sometimes profusely. Pyogenic granulomas are more common during pregnancy and can be seen on the gingival mucosa. The most frequent oral location of involvement is the gingival mucosa. They rarely resolve spontaneously. The differential diagnosis is usually between pyogenic granuloma and other vascularappearing tumors including metastatic carcinoma, particularly renal cell carcinoma, bacillary angiomatosis, and amelanotic melanoma. Pyogenic granulomas are almost always removed and the diagnosis is confirmed by histopathologic evaluation.
Pathogenesis: Pyogenic granulomas are thought to arise after trauma or secondary to medications and to be caused by a hyperplastic proliferation of vascular tissue. Chronic localized trauma can cause the release of vascular growth factors that may induce the proliferation. Pyogenic granulomas have not been shown to have any genetic inheritance pattern and are considered to be sporadic. The exact mechanism of formation is not well understood. The fact that they are more commonly seen in pregnancy suggests that certain hormonal regulations play a role in the formation of these tumors.
Histology: Pyogenic granulomas are also known as lobular capillary hemangiomas. This is an excellent descriptive name. The lesion is an exophytic growth that has a lobular configuration to its growth pattern. The tumor is typically well circumscribed and surrounded by a collarette of hyperplastic epithelium. Multiple capillary loops are found within each of the tumor lobules. Strands of fibrous tissue divide the tumor into individual lobules of varying size. Many of these lesions show evidence of surface ulceration result- ing from thinning of the overlying epidermis. The cells involved are bland appearing.
Treatment: Most pyogenic granulomas resolve after shave removal and curettage with cautery of the base of the lesion. These tumors do have a propensity to recur, and occasionally an elliptical excision is required for removal. Application of silver nitrate and laser ablation with the pulsed dye laser have been used successfully. If the pyogenic granulomas are drug induced, stopping the offending medication is sometimes effective in resolving them. However, many cases of medicationinduced pyogenic granulomas require some method of surgical removal.